Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Biocompatibilidade e comportamento de compósitos de hidroxiapatita em falha óssea na ulna de coelhos Biocompatibility and behavior of hydroxyapatite on bone defect on rabbit's ulna

Avaliaram-se os compósitos de hidroxiapatita sintética e carbono (HAC) e hidroxiapatita sintética, carbono e fosfato biácido de sódio (HACF), ambos na forma sólida, como substituto ósseo em 36 coelhos adultos. Após protocolos anestésico e cirúrgico habituais, retirou-se um fragmento de aproximadamente 2cm de comprimento no terço médio da ulna esquerda. Os animais do grupo 1 receberam, em cada falha provocada, blocos de HAC e HACF, e os do grupo 2 somente HAC. Os do grupo 3 não receberam tratamento. Os animais foram submetidos a avaliações clínicas e radiológicas nos dias 8, 15, 30, 60, 120 e 180 de pós-operatório. Nas mesmas datas, dois animais de cada grupo foram sacrificados e deles colheu-se material para histologia. Observou-se evolução normal da regeneração óssea em todos os animais, sendo mais precoce nos dos grupos que receberam os compósitos. O uso de HAC e HACF na ulna de coelho mostrou-se um método eficiente, não apresentando sinais de infecção e nem evidência de rejeição.Composites of synthetic hydroxyapatite and carbon (HAC) and synthetic hydroxyapatite, carbon and sodium biacid phosphate (HACF), both of them in solid form, as substitute in bone regeneration were studied. Thirty-six rabbits divided in three groups were used. After routine anesthetic and surgical procedure, a bone fragment with two-centimeter in length was taken from the middle part of the left ulna. Animals from group 1 received one block of HAC and HACF, from group 2 received only HAC, in the criated bone defect, and animals from group 3 did not receive any treatment. They were submitted to clinical and radiographic examinations at 8, 15, 30, 60, 120 and 180 days after surgery to evaluate bone healing. At the same dates, two animals of each group were enthanised and bone fragments were collected for histological evaluations. The results showed normal evolution of bone regeneration in all groups but faster in animals that received the composites. The use of HAC and HACF showed to be efficient and biocompatible, and not caused rejection

The roles of the nucleus accumbens core, dorsomedial striatum, and dorsolateral striatum in learning : performance and extinction of Pavlovian fear conditioned responses and instrumental avoidance responses

This study examined the effects of bilateral excitotoxic lesions of the nucleus accumbens core (NAc-co), dorsomedial striatum (DMS) or dorsolateral striatum (DLS) of rats on the learning and extinction of Pavlovian and instrumental components of conditioned avoidance responses (CARs). None of the lesions caused sensorimotor deficits that could affect locomotion. Lesions of the NAc-co, but not DMS or DLS, decreased unconditioned and conditioned freezing. The NAc-co and DLS lesioned rats learned the 2-way active avoidance task more slowly. These results suggest: (i) CARs depend on both Pavlovian and instrumental learning; (ii) learning the Pavlovian component of CARs depends on the NAc-co; learning the instrumental component of CARs depends on the DLS, NAc and DMS; (iii) although the NAc-co is also needed for learning the instrumental component, it is not clear whether it plays a role in learning the instrumental component per se or if it simply allows learning of the Pavlovian component which is a pre-condition for learning the instrumental component; (iv) we did not find evidence that the DMS and DLS play the same roles in habit and goal-directed aspects of the instrumental component of CARs as observed in appetitive motivated instrumental responding